Author: Monica Reinagel, MS, LDN

How to Avoid Overeating This Thanksgiving

by Monica Reinagel, MS, LDN

Thanksgiving is a time to gather with friends and family, be grateful for all we have,  and stuff ourselves silly. I’m not that concerned about the long term consequences of this. As I’ve said before, a single day of excess isn’t going to make you gain weight any more than a one-day juice fast is going to make you lose weight.

Nonetheless, it’s no fun to push yourself away from the table and realize – too late! – that you’ve eaten to the point of discomfort.

Here are 5 strategies that can help you enjoy this year’s feast without regrets:

This episode is also available as a podcast. Click to listen.

Thanksgiving Tip #1: Keep the Appetizers Light

The traditional Thanksgiving menu features a lot of heavy, rich dishes – lots of starches, creamy casseroles, and everything is dripping with butter and gravy. It’s not a light meal. Unfortunately, the pre-dinner snacks tend to be just as heavy and rich as the main event! All too often people sit down to dinner already half-full from the snacks they’ve been nibbling all afternoon while dinner is prepared.

Rather than filling up on calorie-dense appetizers like cheese and crackers, clam dip, nuts, and bacon-wrapped pineapple chunks, keep the pre-dinner snacks light: crisp radishes and snow peas with a yogurt based dip, kale chips, and steamed edamame, for example. Clearing away all the snacks about an hour before dinner will also help ensure that people sit down to the table with an appetite.

Thanksgiving Tip #2: Use Smaller Plates

Research shows that when we use smaller plates, we serve ourselves smaller portions, consume fewer calories, but feel just as satisfied as we do after eating more calories off of larger plates. Now consider that the average size of dinner plates has gone from 9 to 13 inches over the last 30 years and our rising rates of obesity don’t seem that surprising.

See also: Why We Overeat

Do yourself and your guests a favor by setting the table with smaller plates. Grandma’s china is probably a lot smaller than your modern dinnerware. Alternatively, the salad or sandwich plates from your oversized set might be perfect.  The same holds true for things like wine glasses and forks: They larger they are, the more we consume. Downsizing your serving ware will not only help you eat a bit less without even noticing, It’ll also make your table less crowded.

Thanksgiving Tip #3: Serve the Vegetables First

If you start by filling your plate with stuffing, mashed potatoes, and candied yams, you’re likely to be out of room by the time you get to the string beans, Brussels sprouts, and carrots. Reverse the trend by helping yourself to turkey and all the vegetables first, leaving less room on the plate for the starchy fillers.

If you’re in charge of all or part of the menu this year, try to ensure that there are at least as many vegetables as starches – and resist the temptation to smother them all in cheese, cream of mushroom soup, and/or fried onions. Some crisp and colorful vegetables, lightly steamed and topped with a bright squeeze of lemon juice or fresh herbs, provide a welcome contrast to all the other dense and heavy dishes.

Some of my favorite vegetables sides for Thanksgiving include steamed carrots lightly glazed in ginger and a bit of butter, tender-crisp green beans tossed with cilantro and garlic, and a very lightly-dressed coleslaw or pickled vegetables.

Thanksgiving Tip #4: Choose Your Starch

One of the things that makes Thanksgiving dinner so devastating is all the redundant starches.  During the rest of the year, a dinner menu might feature a protein, a starch, and a vegetable. Or, at my house, we often skip the starch altogether and have a second (or third) vegetable instead.

But the traditional Thanksgiving menu includes a bird stuffed with bread, at least one or two types of potatoes, rolls – and often several other starches as well. And research shows that we eat more when we have a greater variety than we do when our choices are more limited.

If you are cooking this year, consider reigning in the madness a bit. Stuffing and potatoes might be non-negotiable, but would anyone really miss the rolls? Is it really necessary to serve mashed potatoes, roasted potatoes, and scalloped potatoes?  Even if you have no control over the menu, you can also choose to eat only one of the many starch dishes this year instead of all of them.

Thanksgiving Tip #5: You Don’t Have to Sample Everything

When we go to a restaurant, we don’t feel that we have to order every single thing on the menu just because the chef has prepared them. We choose our favorite item, and feel no sense of loss or deprivation. But somehow when faced with a Thanksgiving buffet of 20 different dishes, we feel duty-bound to sample every single one.

By all means, marvel over the beautiful array of colors and aromas and compliment the chef(s) on the amazing spread. Then, just as you would when handed a menu full of delicious options, choose what you’d like to enjoy that evening…and enjoy the heck out of it. Likewise, when it comes to dessert, it is not necessary to have a “small” piece of all 5 desserts any more than you’d order every item on a dessert menu.

There’s a sort of madness that sets in at Thanksgiving, as if this will be the last pumpkin pie we will ever see. But Thanksgiving actually comes every year – and the menu doesn’t change all that much! Barring catastrophe, your life is likely to include many more pumpkin pies, all of which will taste very similar to the dozens of pumpkin pies you’ve had before.  When I remind myself of that, it seems to put things back into perspective, allowing me to make my decision based on how much room I actually have left in my stomach and which dessert looks particularly appealing or unusual.

Originally published at QuickandDirtyTips.com

Are decorative pumpkins and gourds edible?

by Monica Reinagel, MS, LDN

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Jessica writes:

“We just threw out the pumpkins we had on our porch as decoration, and it made me wonder whether we could have eaten them. I bought them at the grocery store after all! 

Can you eat/cook any type of pumpkin? (I had a mix of regular, Cinderella, and maybe Yokohama.) If you can eat them, how long after you put them on your porch will they be edible? I’ve only used canned pumpkin to date, is the process of making your own challenging?”

Continue reading “Are decorative pumpkins and gourds edible?” >

How Fitness Trackers Sabotage Weight Loss

by Monica Reinagel, MS, LDN

Lots of people use diet and activity trackers to log their food intake and exercise. After all, there’s an old saying that “you can’t manage what you don’t measure.” And yet it seems to be backfiring.

I get email after email from people using these trackers who can’t understand why they’re not losing weight. They’re entering in every morsel of food and logging every activity. According to their trackers, they should be shedding two or three pounds a week. And yet the scale hasn’t budged—or they’ve actually gained weight!

This article is also available as a podcast. Click to listen

The problem with net calories

Here’s how many of these trackers work: You start every day with a certain number of calories to spend. That number is based on your height, weight, age, sex, activity level, and your goals—that is, whether you’re trying to lose, gain, or maintain your current weight.

Calories are subtracted from your balance as you log your meals into the diet tracker over the course of the day. Ideally, you don’t get to zero too early in the day. But if you do, there’s a solution. Let’s say it’s 5 pm and I’m down to my last 400 calories. But wait! I can take an evening run, log it into the app and now I’ve got 840 calories to spend on dinner! How awesome is that?

The general principle here is sound: The more you move, the more you can eat. In practice, however, these “net calorie” calculations are inaccurate and misleading—and they are suckering people into eating too many calories. Let me explain.

How logging exercise leads you astray

Although diet tracking apps can help you get an accurate picture of your calorie intake, they are much less reliable in determining how many calories you burn. Here are at three ways they tend to get it wrong.

Mistake #1: Your baseline may be too high.  In order to calculate your baseline calorie requirements, you indicate your activity level: sedentary, lightly active, moderately active, or very active. This does not refer to how much you exercise (we’ll get to that in a moment). This is just about your daily activity level. And guess what? Most people select an activity level that’s one or two categories higher than their lifestyle actually warrants. Unless you rope cattle eight hours a day, your lifestyle probably does not qualify as “very active.”

If you use a wearable fitness tracker like a Fitbit or Apple Watch or even a low-tech pedometer or step counter, you can use that to help you select the proper category for your lifestyle. Here’s an easy cheat sheet:

  • Fewer than 1,000 steps a day is Sedentary.
  • Fewer than 10,000 steps or about four miles a day is Lightly Active.
  • Ten to 23,000 steps or four to 10 miles a day is considered Active.
  • More than 23,000 steps or 10 miles a day is Highly Active.

If you walk or run for exercise, you can count those steps and/or miles toward your baseline activity level if you want, but then you can’t enter them again as exercise. They’ve already been counted.

Mistake #2: The calories burned from additional activity are often overestimated.  Most diet tracking apps give you a place to manually log physical activities and exercise, such as a spinning class or yard work or ballroom dancing. Alternatively, there are wearable devices that sense your movement and changes in your heart rate.  Either way, you may not be burning anywhere near as many calories as your app thinks. As with the readouts on the aerobic equipment at your gym, diet and fitness trackers may overestimate calories burned by anywhere from 10% to 25%.

For one thing, the more you do a given exercise, the more efficient your body becomes at performing that motion. As a result, you burn fewer calories. The first time I run an eight-minute mile, I’m probably going to burn more calories than the 100th time I run an eight-minute mile.

Not only that, but when we burn a bunch of calories exercising, our body actually adjusts by burning fewer calories the rest of the day.  A new study finds that the body of a reasonably fit person may “recover” up to 28% of the calories burned through exercise by burning fewer calories at rest.  Ironically, the more fat tissue you have, the greater this effect.  As researcher John Speakman explains,

“When your smart watch tells you that you burned 300 calories on your run it may be correct (probably isn’t). But even if it is correct, you should not be deluded into thinking you can now eat 300 calories more food.”

Mistake #3: You may be counting some of those calories  twice.  If I spend the next hour sitting at my computer writing this podcast episode, I’ll burn about 100 calories. Those non-active calories are already accounted for in my daily calorie allowance. If I spent the next hour on the stationary bike instead, I’d burn 500 calories. That’s 400 more calories than I would have burned writing this episode. But if I log my bike ride into my diet tracker, it doesn’t add 400 calories to my total allowance … it adds 500. Essentially, it counts those 100 baseline calories twice.

The more activities you enter in to your exercise diary, the more this double-dipping error compounds—especially if you’re logging a lot of low-intensity activities like housecleaning or yoga.

I recently heard from a Nutrition Diva listener who said she burned 3,000 calories a day. She was only eating 2,500. She couldn’t figure out why she was gaining weight.  Sure enough, she was using an app to track her food intake and exercise.

According to her app, her baseline calorie needs were about 1,800 calories a day. She then logged activities for almost every hour of her day: making beds, folding laundry, unloading the dishwasher, yoga class, walking the dog, grocery shopping, car-pool, weeding the garden, playing the piano, cooking dinner, folding laundry, and so on. According to her tracker, all those activities were burning an extra 1,200 calories a day—which gave her a total “net calorie” allowance of 3,000 calories a day. She figured she could eat 2,500 calories a day and still lose weight.

In reality, all of her routine activities probably only burned a couple hundred calories above and beyond her baseline. Instead of eating 500 calories less than she burned each day, she was really eating 500 calories more than she burned each day. No wonder she wasn’t losing weight!

How to avoid the net calorie trap

Activity trackers are a great way to keep track of how active you are, but they aren’t very accurate at estimating your calorie expenditure. Adding “calories burned” to your daily calorie allowance can result in unintended weight gain.  So, I’d suggest that you don’t log your exercise and other activities into your diet tracker or sync your wearable fitness tracker to your diet log. Even better, I’d encourage you to stop thinking of exercise as simply way to burn calories or earn food and focus on the many other benefits it provides instead.

See also: What if exercise burned zero calories?

Sources

  1. Careau, Halsey, et al.. Energy compensation and adiposity in humans. 2021. https://www.cell.com/current-biology/fulltext/S0960-9822(21)01120-9.

 

Originally published at QuickandDirtyTips.com

Nutrition comparison of gluten-free flours

by Monica Reinagel, MS, LDN

In this week’s episode of the Nutrition Diva podcast, I reviewed the nutritional benefits of watermelon seed flour in comparison to other gluten- and grain-free flours. You can listen to the episode here and below is a chart showing the nutritional values for several of the most common types.

1/4 cupCaloriesProtein (g)Fat (g)Sat fat (g)Carb (g)Fiber (g)Calcium (mg)Potassium (mg)
Watermelon seed flour17891535017207
Almond flour16061206472210
Coconut flour12063218106600
Cassava flour13000031220106
Gluten-free baking flour130200301459
Paleo baking flour110440.513327160
White pastry flour12030.50261658
Whole wheat pastry flour11040.502337111

What’s the healthiest way to eat rice?

by Monica Reinagel, MS, LDN

In this episode of the Nutrition Diva podcast, I break down the differences between all the different types of rice. Which are most nutritious? Easiest on your blood sugar?

Nutritional comparison of rice varieties

1/2 cup, cookedCalories (kcal)Protein (g)Fat (g)Carbs (g)Fiber (g)Mg (%DV)
White, long grain1052022<12.4%
White, short grain1352029<12.1%
White, converted95202111.8%
Basmati (white)902021<12.4%
Jasmine (white)1052022<12.4%
Brown, long grain12531261.59.8%
Brown, medium grain1102123210.7%
Brown, converted11521241.37.6%
Black rice11531231~
Red rice11021232~
Wild rice8530181.56.5%
Haiga1022021<1~
Glutinous (sticky) rice852018<11%

How do pili nuts compare nutritionally?

by Monica Reinagel, MS, LDN

This week’s Nutrition Diva podcast is all about the pili nut, the latest entry into the superfood derby.  Below is a chart showing how they stack up to other nuts nutritionally.

1 oz/30 g provides:Pili nutsAlmondsWalnutPeanutCashewMacadamiaCoconut
Calories200164185161157204101
Fat22 g14 g18 g14 g12.5 g21.5 g9.5 g
Saturated10 g1 g2 g2 g2 g3 g8.5 g
Monounsat.10 g9 g2.5 g7 g7 g17 g1.4 g
Omega 3----2.5 mg-- ------
Protein3 g6 g4 g7.5 g5 g2 g1 g
Fiber1 g3.5 g2 g2.5 g1 g2 g2.5 g
Vitamin E10 mg7 mg02 mg-----
Calcium40 mg76 mg28 mg26 mg10 mg24 mg4 mg
Magnesium85 mg76 mg45 mg48 mg83 mg37 mg9 mg

Why weight loss is harder for some people

by Monica Reinagel, MS, LDN

If you have excess body weight, the standard advice is to eat less and move more. Of course, we all know this is easier said than done.

For one thing, it takes a lot of work to change deeply ingrained habits and behavior patterns. It’s hard to move more when our workplaces are designed for sitting and our neighborhoods are designed for driving. It’s hard to eat less when you’re constantly surrounded by hyper-palatable food. It’s also challenging to eat less when you’ve learned to use food to cope with stress or soothe your emotions.

These are all issues that a good behavior modification program can help with. But It’s also really hard to eat less when your brain is sending you the wrong signals about whether you’ve had enough to eat.

This article is also available as a podcast. Click to listen.

If you have excess body weight, the standard advice is to eat less and move more. Of course, we all know this is easier said than done.

Hunger (the urge to eat or to seek food) and satiation (the feeling that you’re full and don’t want more food) are both regulated in the hypothalamus, the most primitive part of the brain. The hypothalamus responds to hormonal signals being sent from different organs of the body via various chemical messengers. When this system is working as it should, our hunger increases when our body needs energy and decreases when it doesn’t. The result is a stable body weight.

But sometimes, the system goes awry. Dr. Gabriel Smolarz is an endocrinologist specializing in the treatment of obesity. Here’s how he explains it:

“The hypothalamus is receiving all of these different inputs and processing the situation to then say: Should we eat? Should we not eat? Should we stop eating? We conclude that there’s dysregulation when the gas tank is full, but the hypothalamus is indicating an empty tank.”

If your brain is receiving the wrong signals about whether or not you need food, this is obviously going to make it much more difficult for you to eat less.

Are genetics to blame for obesity?

Dysregulation of appetite signals can be due to genetics—similar to the way you might inherit a dysfunction in your body’s ability to regulate your cholesterol levels or blood pressure. This may be at least part of the reason that obesity, like high cholesterol, runs in families.

Of course, our genetics haven’t changed that much in the last 100 years, while the incidence of obesity has skyrocketed. But genes aren’t always destiny. Sometimes they need an environmental trigger to unfold. What’s changed in the last 100 years is not our genetics but the environmental triggers.

What’s changed in the last 100 years is not our genetics but the environmental triggers.

We are more sedentary than previous generations. And at the same time, our food supply has gotten cheaper, more convenient, and it’s processed in ways that make it more tempting. The combination of dysregulated appetite signals with cheap and abundant high-calorie, hyper-palatable food is clearly a recipe for disaster.

This situation can be compounded by something referred to as metabolic adaptation, in which the body responds to caloric restriction by burning fewer calories and amping up the urge to eat. Here’s Dr. Smolarz again:

“If you are fortunate enough to achieve a meaningful weight loss, it’s really hard to keep that weight off. It’s basically the body saying, Oh, no, this is not good. Higher weight is better, safer, and more conducive to reproduction and survival. So after the weight loss, you’re hungrier than you were before, because of this hormonal part of metabolic adaptation.

“And then the second half of this story has to do with how much energy you burn at rest. The body says, We’re now going to conserve as many calories as we can by burning less. So if it took you a hundred calories to walk around the block, your body says, Well, we can now do this in 80 calories.

“So you’ve increased your efficiency. And if you want to continue to lose weight, you need to consume even less than you did just a few weeks ago, because now your resting energy expenditure is lower than it was before.”

One of the reasons that I advocate a slower pace of weight loss than is commonly prescribed is to minimize the unwanted metabolic adaptation. However, those with a long history of crash or yo-yo dieting may have lasting effects that make weight loss increasingly difficult.

While it’s true that if you eat less you will lose weight, it’s not an even playing field.

So while it’s true that if you eat less you will lose weight, it’s not an even playing field. One person might be able to lose a couple of pounds by cutting out a dessert here and there and taking a walk after dinner. But some people have to eat a lot less (or go around feeling hungry all the time) in order to lose a pound or maintain a lower body weight.

Is there any way to fix appetite dysregulation?

There are a variety of medications that work in the hypothalamus to regulate appetite signals. For those suffering from a dysregulation of appetite, where the hunger signals are out of sync with what their bodies actually need, these medications can make it easier to eat less and lose weight.

Several drugs have been approved by the FDA for the treatment of obesity. Some of these are similar to drugs that have been approved for the treatment of other conditions, such as Type 2 diabetes, but have been found in clinical trials to be effective in the treatment of obesity as well. (The two conditions frequently occur together.)

In the past few months, there’s been a lot of buzz about a Type 2 diabetes drug called semaglutide, which appears to be even more effective at promoting weight loss than some of the drugs approved to treat obesity.

In the most recent study, participants received intensive behavioral counseling along with a weekly injection of semaglutide or a placebo. Those receiving the behavioral counseling and a placebo succeeded in losing an average of 5% of their body weight … which is no small accomplishment. However, those who combined intensive behavior modification with the medication lost over 15% on average.

Important!
Disclosure: In addition to his work as a clinician and on the clinical teaching faculty of Rutgers Medical School, Dr. Smolarz also serves as Medical Director for Novo Nordisk, the company that developed semaglutide.

Why are these medications so under-utilized?

When you consider the prevalence of obesity and its enormous costs to individuals and society, you might think that these drugs would be more widely used.

If a person develops high blood pressure, high cholesterol, or high blood sugar, their doctor will probably suggest that they make some changes to their diet and get more exercise. And for some people, lifestyle change is sufficient to solve the problem. But for others, often those with a genetic predisposition, even the most diligent efforts with diet and lifestyle don’t fix it. At that point, the doctor will likely prescribe a medication to help modulate whatever aspect of their metabolism is out of whack.

Similarly, when a person has excess body weight, their doctor (if they mention it at all) will usually suggest that they eat less and move more. But if they are unable to get their weight down, rarely are medications discussed.

As pharmacist and obesity advocate Ted Kyle points out, 88% of people with Type 2 diabetes are prescribed medication to manage their blood sugar. And yet, anti-obesity medications are prescribed to only 3% of those with obesity. (And that’s doubled in the last ten years.)

I asked Dr. Smolarz why he thinks this is.

“I went to an allopathic medical school and a mainstream internal medicine residency program. I did a mainstream endocrinology fellowship. What I like to call essential obesity was not part of any curriculum. This dysregulation of appetite was not taught.

“Obesity is the most prevalent non-communicable disease on the planet. And we learn more about bioterrorism and how to use potassium iodide than how to use medicines in this regard.”

Not everyone who needs to lose weight needs an anti-obesity medication, of course.  Dr. Smolarz describes how he evaluates patients seeking treatment for obesity.

“You want to look for secondary causes of extra weight first, Are there other medicines that the person is taking that promote weight gain?

“There are also underlying medical conditions that could be causing this. An underactive thyroid can contribute to weight gain and be a cause of an inability to lose weight. So that’s something we would check for. Is this person perhaps an emotional eater or traumatic eater?  Maybe it’s a sleep problem.”

In addition to treating any underlying medication conditions that may be contributing to the problem, the first line of treatment is still to modify the diet, increase physical activity, and address behaviors that may be leading to overeating. But that’s not where treatment always ends.

Dr. Smolarz:

“There is no blood test that tells me you have an appetite signaling problem. I wish there was something like that. You cross things off the list, and then you say, Well, it’s not this, it’s not that. OK, I’m left with this. And so let’s approach that.

“The first part of the treatment is to ensure three key pieces: optimal nutrition, increasing physical activity, and behavior modification. I say someone is a candidate for medications when those three elements have been tried or are being currently tried, but we’re not seeing weight come off. “

However, even if appetite signals are out of whack, medication alone won’t solve the problem. Nutrition, physical activity, and behavior modification still need to be part of the program.

Dr. Smolarz:

“The medications are enabling those fundamentals to be even more successful.  The medicines allow you to tolerate a reduced caloric intake. So it’s one thing to say, You need to eat salad twice a day. You may be very hungry at 1200 or 1500 calories a day. The medicines that act as appetite suppressants make that feasible.”

Like all medications, the drugs used to treat obesity have a risk of side effects. Patients and doctors need to weigh the costs and benefits of the various medication options and select the one that is the best match for their situation. And this may be another reason that family doctors are reluctant to prescribe anti-obesity medications.

Here’s Dr. Smolarz again:

“All the drugs work a little bit differently, so it’s a bit of a challenge to master it all. Then the last piece is [the] fundamental misunderstanding of obesity as just a failure of willpower, that people just need to eat better and they should get a handle on their obesity. That’s just not the clinical reality.”

How to find help

If your health is at risk because of excess body weight and you and your doctor feel you have run out of solutions, you might consider consulting with a practitioner specifically trained in obesity medicine, which involves much more than just writing prescriptions or scheduling bariatric surgery.

The American Board of Obesity Medicine trains and certifies physicians in obesity management. Their website includes a directory where you can find Diplomates by location. The Obesity Medicine Association is another resource that can help you locate clinicians with specific training in obesity medicine.

Originally published at QuickandDirtyTips.com

What’s the latest on A2 milk?

by Monica Reinagel, MS, LDN

[Transcript]

There’s a certain amount of a genetic variation in dairy cows, just the way there is with people. That’s why some of us are left-handed and some of us have red hair!  And for Dairy cattle, one of those genetic variations leads to tiny differences in the proteins in their milk.

Beta-casein is the main protein in cow’s milk. And most of the dairy cattle here in the U.S. produce milk that contains two forms of beta casein…the A1 form and the A2 forms.  But some cattle produce milk that contains only the A2 form of beta casein.

The milk looks and tastes exactly the same. It has the same nutritional profile—same amount of protein, calcium, same amount of lactose. 

About 25% of the Western population experiences some degree of digestive discomfort after consuming cow’s milk…things like gas, bloating, or loose stools. We’re not talking about a milk allergy…that’s far less common and potentially more serious.  These digestive symptoms are relatively harmless and temporary but they can be uncomfortable and inconvenient.  And they are thought to be due to an inability to breakdown lactose, which is sugar in milk.

There are a few things you can do: You can avoid dairy products. You can take a lactase supplement when you eat dairy products, that’s an enzyme that helps break down the lactose so that it doesn’t cause problems. Or you can buy dairy products that have the lactose removed or reduced. 

And there are now a handful of studies showing that for people with known lactose intolerance or who suspect they are lactose intolerant, drinking A2 milk, which  only contains the A2 form of beta casein protein, may cause fewer digestive symptoms. 

I think this is something that individuals will need to try for themselves to see whether or not it makes a difference for them. And if it doesn’t, there are other options for people who have trouble with dairy, such as the lactase supplements and lactose free milk.

It’s important to note that at this time there no other known benefits to consuming only the A2 protein and no other known risks of consuming the A1 form.

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